Active NPI
Shannon Sullivan, DDS
- Dentist
- New York, NY
National Provider Identifier
1407267164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 024571
- Practice address
- 100 Haven Ave
New York, NY 10032-2645 - Phone
- (212) 342-0107
- NPI assigned
- May 15, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 024571 | OH | Primary |
Addresses
Primary practice location
100 Haven Ave
New York, NY 10032-2645
Mailing address
100 Haven Ave
New York, NY 10032-2645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140730002848 | OH | Order and Referring Only - Oral Surgery | 2062638802 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024571 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1407267164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 HAVEN AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100322645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 HAVEN AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100322645",
"telephone_number": "212-342-0107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SHANNON",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-15",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "024571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.